Obesity fuels fears of faster diabetes rise

Pedestrians wait to walk across a street near Times Square in New York August 28, 2007.

Reuters/Lucas Jackson

CHENNAI, India The prevalence of diabetes worldwide will far outstrip even the sharp increase currently projected unless rising trends of obesity are controlled, health experts said on Saturday.

Adult-onset diabetes has been linked to risk factors like aging, an inactive lifestyle, unhealthy diets, smoking, alcohol and obesity. The silent, chronic disease damages the heart, blood vessels, eyes, kidneys and nerves and was responsible for 3.8 million deaths worldwide in 2007.

The International Diabetes Foundation estimates a current prevalence of 246 million diabetes cases worldwide and projects it will hit 380 million by 2025, but experts say these figures may well be an underestimate.

"The projections are conservative because they take into account only aging and urbanization but not obesity, which if unarrested, will lead to more cases," Gojka Roglic of the World Health Organization's diabetes program told a regional diabetes conference in Chennai, southern India.

Roglic said not a single country in the world had shown any signs of a plateau for obesity.

"It's the responsibility of governments to enable populations to create the conditions where (healthy) lifestyle is an easy choice rather than something that's very difficult to achieve," Roglic told Reuters.

"If you don't have a park to walk in, if the traffic is too dangerous, then people won't be encouraged to walk or ride bicycles. Or if there is crime and someone will kill you for your bike, then you won't be encouraged to cycle."

DOUBLE JEOPARDY

Anthony Harries, senior adviser with the London-based International Union Against Tuberculosis (TB) and Lung Diseases, warned of the increased risks of developing active tuberculosis that come with diabetes.

"It was recognized even in ancient Roman times that people with urine that was sweet had increased risk of tuberculosis," he told the conference, adding that a diabetic was three times more likely to develop active TB than a non-diabetic.

One in every three people in the world is infected with TB bacilli. But not everyone who is infected with TB gets sick. Chances of developing active TB rise when one's immune system is weak, for example when compromised by a chronic illness.

India carries the highest diabetes burden in the world, with 41 million cases in 2007, projected to hit 70 million by 2025.

The problem is worsening in rural India, which now has a prevalence of 9.2 percent among people aged 20 years and older, up from 2.2 percent in 1983. The rate in urban areas is 18.6 percent, compared with 11.2 percent in 1998.

Apart from a more sedentary lifestyle, experts say the propensity for diabetes among Indians may also be due to a switch, linked to rising affluence, to eating polished rice which has much more sugar than crude, unpolished rice.

Genetics may also play a part.

"Years ago, people had famines and then they had plenty. During times of plenty, food will be stored, so when there is little food in the next three months, they burn off all that," said Viswanathan Mohan, a diabetes specialist who runs a program to reduce diabetes and its harms in the countryside.

"Now the famines are gone, it is feasting all the time but the genes have not changed because this has just happened over 30 years. So when you overeat and reduce physical activity and when you have 'thrifty genes' (geared toward storing energy), you are heading toward diabetes," Mohan said.